Extraarticular Subtalar Arthrodesis for Pes Planovalgus: An Interim Result of 50 Feet in Patients with Spastic Diplegia

Abstract

BackgroundThere are no reports of the pressure changes across the foot after extraarticular subtalar arthrodesis for a planovalgus foot deformity in cerebral palsy. This paper reviews our results of extraarticular subtalar arthrodesis using a cannulated screw and cancellous bone graft.MethodsFifty planovalgus feet in 30 patients with spastic diplegia were included. The mean age at the time of surgery was 9 years, and the mean follow-up period was 3 years. The radiographic, gait, and dynamic foot pressure changes after surgery were investigated.ResultsAll patients showed union and no recurrence of the deformity. Correction of the abduction of the forefoot, subluxation of the talonavicular joint, and the hindfoot valgus was confirmed radiographically. However, the calcaneal pitch was not improved significantly after surgery. Peak dorsiflexion of the ankle during the stance phase was increased after surgery, and the peak plantarflexion at push off was decreased. The peak ankle plantar flexion moment and power were also decreased. Postoperative elevation of the medial longitudinal arch was expressed as a decreased relative vertical impulse of the medial midfoot and an increased relative vertical impulse (RVI) of the lateral midfoot. However, the lower than normal RVI of the 1st and 2nd metatarsal head after surgery suggested uncorrected forefoot supination. The anteroposterior and lateral paths of the center of pressure were improved postoperatively.ConclusionsOur experience suggests that the index operation reliably corrects the hindfoot valgus in patients with spastic diplegia. Although the operation corrects the plantar flexion of the talus, it does not necessarily correct the plantarflexed calcaneus and forefoot supination. However, these findings are short-term and longer term observations will be needed.

Brief communication: A midtarsal (midfoot) break in the human foot

“…Though this index is not a direct measure of midtarsal pronation, it was designed as a proxy for foot pronation (Song et al, 1996), and has been used by others as a pressure-based measure of foot pronation (Yoon et al, 2010;Hillstrom et al, 2013). Though this index is not a direct measure of midtarsal pronation, it was designed as a proxy for foot pronation (Song et al, 1996), and has been used by others as a pressure-based measure of foot pronation (Yoon et al, 2010;Hillstrom et al, 2013).…”

Die extraartikuläre Arthrodese nach Grice und Green mit Implantation eines Fibulaspans – Nachuntersuchung von 92 Patienten

“…merken ist in diesem Fall sicherlich der relativ kurze Nachuntersuchungszeitraum. Langzeitstudien haben eine Nachhaltigkeit der Ergebnisse auch über 10 Jahre beschrieben [6,7,9,12,13,17]. Durch die Methode nach Grice und Green kann eine Stabilität im unteren Sprunggelenk erreicht werden, ohne Gelenkflächen zu zerstören.…”

The effect of subtalar inversion/eversion on the dynamic function of the tibialis anterior, soleus, and gastrocnemius during the stance phase of gait

“…Since a previous study indicated that the COP path tends to move medially in foot pronation and laterally in supination [18], the following modifications to groundfoot contact were made: heel ground contact was modeled as rolling of a rigid sphere with a local coordinate system over a rigid plate (according to Hagman [19]). The new contact point in the configuration of subtalar inversion or eversion was estimated as the most inferior point of the sphere after rotating 108 or 208 along the subtalar joint axis (Fig.…”